1470nm激光汽化术通道法治疗晚期前列腺癌并膀胱出口梗阻
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摘要
目的探讨经尿道运用1 470 nm激光汽化术通道法治疗晚期前列腺癌伴膀胱出口梗阻的临床疗效。方法回顾分析我院2014年10月至2017年4月采用1 470 nm激光汽化术通道法治疗23例Ⅱ-Ⅳ期晚期前列腺癌患者,所有患者已失去根治性前列腺切除手术机会,均有上尿路症状、尿潴留等不同程度膀胱出口梗阻表现。对患者术前及术后3个月随访的国际前列腺症状评分、生活质量评分、最大尿流率、残余尿量进行比较。对同意行去势手术的4例患者同时行双侧睾丸切除术,其余患者行促黄体激素释放激素类似物药物(戈舍瑞林等)去势治疗。所有患者术后均长期口服比卡鲁胺(50 mg,1次/日)。结果术前与术后3个月比较患者下尿路症状均明显减轻,国际前列腺症状评分[(25.7±4.2)分vs(7.2±3.5)分,P<0.001]、生活质量评分[(4.4±0.3)分vs(2.4±0.4)分,P<0.001]、最大尿流率[(7.5±2.8)ml/s vs(11.0±3.8)ml/s,P<0.001]、残余尿量[(90±21)ml vs(40±8)ml,P<0.001]均有明显改善,所有患者术后3个月复查无肉眼血尿,无尿失禁发生,无死亡病例。结论 1 470 nm激光汽化术通道法治疗晚期前列腺癌并膀胱出口梗阻患者,能快速缓解尿路梗阻症状,治疗效果明显,手术安全,操作简单,术后并发症少。
Objective To investigate the clinical efficacy of transurethral 1470 nm laser vaporization channel method in the treatment of advanced prostate carcinoma with bladder outlet obstruction. Methods Twenty-three patients with stage Ⅱ-Ⅳ advanced prostate carcinoma who underwent 1470 nm laser vaporization channel method in our hospital from October 2014 to April 2017 were analyzed retrospectively; the chance of radical prostatectomy was lost, and different degrees of bladder outlet obstruction such as upper urinary tract symptoms and urinary retention were presented. The international prostate symptom score, quality of life score, Qmax and residual urine volume were compared before and 3 months after treatment by 1 470 nm laser vaporization channel method. Four patients who agreed to receive castration underwent bilateral orchidectomy, and the others received castration with luteinizing hormone-releasing hormone analogue drugs(goserelin, etc.). All patients took 50 mg bicalutamide orally for a long term, with one timeperday. Results Compared with preoperative condition, lower urinary tract symptoms decreased significantly 3 months after operation, with the international prostate symptom score of [(25.7±4.2) vs(7.2±3.5), P<0.01], quality of life score of [(4.4±0.3) vs(2.4±0.4), P<0.01], Qmax of [(7.5±2.8) ml/s vs(11.0±3.8) ml/s, P<0.01 and residual urine volume of [(90±21) ml vs(40±8) ml, P<0.01]. The examination 3 months after operation showed that no gross hematuria, urinary incontinence and deaths occurred. Conclusion The 1470 nm laser vaporization channel method in the treatment of advanced prostate carcinoma with bladder outlet obstruction can relieve symptoms of urinary tract obstruction quickly, characterized by obvious efficacy, high safety, simple operation and fewer postoperative complications.
Objective To investigate the clinical efficacy of transurethral 1470 nm laser vaporization channel method in the treatment of advanced prostate carcinoma with bladder outlet obstruction. Methods Twenty-three patients with stage Ⅱ-Ⅳ advanced prostate carcinoma who underwent 1470 nm laser vaporization channel method in our hospital from October 2014 to April 2017 were analyzed retrospectively; the chance of radical prostatectomy was lost, and different degrees of bladder outlet obstruction such as upper urinary tract symptoms and urinary retention were presented. The international prostate symptom score, quality of life score, Qmax and residual urine volume were compared before and 3 months after treatment by 1 470 nm laser vaporization channel method. Four patients who agreed to receive castration underwent bilateral orchidectomy, and the others received castration with luteinizing hormone-releasing hormone analogue drugs(goserelin, etc.). All patients took 50 mg bicalutamide orally for a long term, with one timeperday. Results Compared with preoperative condition, lower urinary tract symptoms decreased significantly 3 months after operation, with the international prostate symptom score of [(25.7±4.2) vs(7.2±3.5), P<0.01], quality of life score of [(4.4±0.3) vs(2.4±0.4), P<0.01], Qmax of [(7.5±2.8) ml/s vs(11.0±3.8) ml/s, P<0.01 and residual urine volume of [(90±21) ml vs(40±8) ml, P<0.01]. The examination 3 months after operation showed that no gross hematuria, urinary incontinence and deaths occurred. Conclusion The 1470 nm laser vaporization channel method in the treatment of advanced prostate carcinoma with bladder outlet obstruction can relieve symptoms of urinary tract obstruction quickly, characterized by obvious efficacy, high safety, simple operation and fewer postoperative complications.
引文
[1]ASCO修订ACS前列腺癌患者生存指南[J].中国肿瘤临床,2015,42(7):385-385.
[2]那彦群,叶章群,孙颖浩,等.中国泌尿外科诊断治疗指南(2014版)[M].北京:人民卫生出版社,2014:374-380.
[3]张华俊,李月兵,郝建国,等.经尿道等离子电切联合非那雄胺治疗晚期前列腺癌致膀胱出口梗阻的临床价值[J].临床军医杂志,2012,40(3):727-728.
[4]郭佳,刘修恒,胡云飞,等.直出1470 nm半导体激光膀胱肿瘤剜除术治疗膀胱癌的疗效及安全性研究[J].国际泌尿系统杂志,2016,36(6):805-807.
[5]吴序立,郑培奎,黄伟雄,等.双极等离子电切联合经皮膀胱通道钬激光碎石治疗高龄高危前列腺增生合并膀胱结石[J].中国微创外科杂志,2015,12(4):332-335.
[6]Center MM,Jemal A,Lortet-Tieulent J,et al.International variation in prostate cancer incidence and mortality rates[J].Eur Urol,2012,61(6):1079-1092.
[7]枧字,吴瑜璇,芮文斌,等.前列腺癌患者就诊原因分析(附317例报告)[J].临床泌尿外科杂志,2004,19(4),243-244.
[8]Buyyounouski MK,Choyke PL,McKenney PK,et al.Prostate cancer-major changes in the American Joint Committee on Cancer eighth edition cancer staging manual[J].CA Cancer J Clin,2017,67(3):245-253.
[9]ALSH.坎贝尔泌尿外科学(英文版)[M].第8版,北京:科学技术出版社,2001:2383-2388.
[10]Krupski TL,Stukenborg GJ,Moon K,et a1.The relationship of palliatiVC transurethral resection of the prostate with disease progression in patients with prostate cancer[J].BJU Int,2010,106(10):1477-1483.
[11]Luke A,Hardy,Thomas C,et a1.Fried.Rapid sealing of porcine renal blood vessels,ex vivo,using a high power,1470-nm laser,and laparoscopic prototype[J].J Biomed Opt,2017,22(5):58002.
[12]Erol A,Cam K,Tekin A,et al.High power diode laser vaporization of the prostate:Preliminary results for benign prostatie hyperplasia[J].J Urol,2009,182(3):1078-1082.
[13]江东根,肖楚天,庞俊,等.1470 nm激光顺行法前列腺剜除术治疗前列腺增生[J/CD].中华腔镜泌尿外科杂志(电子版),2017,11(1):4-7.
[14]任晓磊,郭俊生,崔向宇,等.1470 nm激光经尿道汽化切除高龄高危浅表性膀胱癌的疗效观察[J/CD].中华腔镜泌尿外科杂志(电子版),2017,11(6):416-418.
[15]周亚,林长丰,李永,等.经尿道前列腺等离子双极电切治疗良性前列腺增生症[J].河北医药,2016,38(10):1533-1537.
[2]那彦群,叶章群,孙颖浩,等.中国泌尿外科诊断治疗指南(2014版)[M].北京:人民卫生出版社,2014:374-380.
[3]张华俊,李月兵,郝建国,等.经尿道等离子电切联合非那雄胺治疗晚期前列腺癌致膀胱出口梗阻的临床价值[J].临床军医杂志,2012,40(3):727-728.
[4]郭佳,刘修恒,胡云飞,等.直出1470 nm半导体激光膀胱肿瘤剜除术治疗膀胱癌的疗效及安全性研究[J].国际泌尿系统杂志,2016,36(6):805-807.
[5]吴序立,郑培奎,黄伟雄,等.双极等离子电切联合经皮膀胱通道钬激光碎石治疗高龄高危前列腺增生合并膀胱结石[J].中国微创外科杂志,2015,12(4):332-335.
[6]Center MM,Jemal A,Lortet-Tieulent J,et al.International variation in prostate cancer incidence and mortality rates[J].Eur Urol,2012,61(6):1079-1092.
[7]枧字,吴瑜璇,芮文斌,等.前列腺癌患者就诊原因分析(附317例报告)[J].临床泌尿外科杂志,2004,19(4),243-244.
[8]Buyyounouski MK,Choyke PL,McKenney PK,et al.Prostate cancer-major changes in the American Joint Committee on Cancer eighth edition cancer staging manual[J].CA Cancer J Clin,2017,67(3):245-253.
[9]ALSH.坎贝尔泌尿外科学(英文版)[M].第8版,北京:科学技术出版社,2001:2383-2388.
[10]Krupski TL,Stukenborg GJ,Moon K,et a1.The relationship of palliatiVC transurethral resection of the prostate with disease progression in patients with prostate cancer[J].BJU Int,2010,106(10):1477-1483.
[11]Luke A,Hardy,Thomas C,et a1.Fried.Rapid sealing of porcine renal blood vessels,ex vivo,using a high power,1470-nm laser,and laparoscopic prototype[J].J Biomed Opt,2017,22(5):58002.
[12]Erol A,Cam K,Tekin A,et al.High power diode laser vaporization of the prostate:Preliminary results for benign prostatie hyperplasia[J].J Urol,2009,182(3):1078-1082.
[13]江东根,肖楚天,庞俊,等.1470 nm激光顺行法前列腺剜除术治疗前列腺增生[J/CD].中华腔镜泌尿外科杂志(电子版),2017,11(1):4-7.
[14]任晓磊,郭俊生,崔向宇,等.1470 nm激光经尿道汽化切除高龄高危浅表性膀胱癌的疗效观察[J/CD].中华腔镜泌尿外科杂志(电子版),2017,11(6):416-418.
[15]周亚,林长丰,李永,等.经尿道前列腺等离子双极电切治疗良性前列腺增生症[J].河北医药,2016,38(10):1533-1537.